Laparoscopic Removal of the Kidney and Ureter (Laparoscopic Nephroureterectomy)

Indications

The kidney and ureter may need to be removed because a cancer has formed in the lining of these structures. This type of cancer is referred to as transitional cell carcinoma of the upper tract. Other reasons include long standing reflux and a non-functioning kidney. In the past this operation required a large incision extending from one's flank to pelvis. Using laparoscopic techniques this same procedure may be performed using small keyhole incisions.

Procedure

Three to four small cylindrical tubes called trochars measuring 5 to 12 mm are placed into the abdominal or retroperitoneal cavity. A video-telescope, called a laparoscope, is placed through one of the trocars. The laparoscope provides the surgeon a magnified view of the operating field and allows identification of vessels and structures with more clarity than is possible in open surgery. Specially designed laparoscopic instruments are placed through the other trochars. This technique allows the surgeon to secure the renal vessels, remove the kidney and ureter from all their surrounding structures with more accuracy and better visualization then the traditional open techniques. Once freed, the kidney and ureter is placed in a specially designed laparoscopic bag and is extracted from a small 3 inch incision often hidden in the pants line.

Results

Not only does the surgeon benefit from better visualization but also the patient benefits by significantly less post-operative pain, shorter hospital stay and quicker recovery to baseline. Several investigators, including our group, have compared laparoscopic nephrectomies to standard open nephrectomies. All investigators concluded that the pain medication requirement , length of stay in the hospital and time to return to work is significantly less in the laparoscopic group. For example, the typical hospital stay for a patient undergoing a traditional open nephrectomy is 5 days and return to baseline activities about 2 months. Using laparoscopic techniques most patients go home within 2 days and back to normal activities in under a month. Finally, this minimally invasive technique provides a better cosmetic result.